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At least 1,153 records · Page 64Linked to original sources
PubMed1999

Periodontal regeneration of intrabony defects using resorbable membranes: determinants of the healing response. An observational clinical study.

The safety and bone-regenerative capacity of a resorbable membrane (Resolut) was evaluated by a nonrandomized prospective clinical study of patients with periodontal defects. Prior to surgical management all patients underwent scaling and root planing and were instructed on oral hygiene. The study included 18 patients (31 periodontal defects) who received surgical treatment by guided tissue regeneration (GTR) using resorbable membranes. The results were evaluated 12 months after surgery in terms of Plaque Index, bleeding index, probing depth, gingival recession, clinical attachment level, and dental mobility. The results obtained show that the use of resorbable membranes in GTR causes few complications. The mean gain in clinical attachment level (4.06 +/- 1.91 mm), with an attachment level gain of more than 3 mm in 81.2% of the defects, suggests the presence of "new attachment." This difference was clinically and statistically significant (t = 11.03, P = 0). The multivariate regression study showed that 60% of the observed variability (F = 11.48, P < 0.001) in clinical attachment level gain was accounted for by the variable's initial probing depth, the Plaque Index of the tooth subjected to GTR, and the infrabony component of the defect.

Absorbable Implants↗
PubMed1999

The local delivery of chlorhexidine in a bioresorbable matrix.

The use of local antimicrobial agents, such as the chlorhexidine chip, should be used cautiously and not without thorough debridement or scaling and root planing of the area in question. Because these chips are basically nonsurgical, patients become enthusiastically excited and relieved to learn they don't need surgery. But patients must be strongly advised that surgical intervention may be a next step in the correction of the periodontal pocket if significant change is not attained with local antimicrobials.

Absorbable Implants↗
PubMed1999

Formation of the biologic width following crown lengthening in nonhuman primates.

The purpose of this study was to determine if and how the biologic width is reestablished following surgical crown lengthening. Crown-lengthening surgery was performed on the right or left maxillary and mandibular central and lateral incisors of three adult monkeys, with contralateral teeth serving as unoperated controls. Twelve weeks after surgery, tissue blocks were removed for histologic analysis. The results of a histometric evaluation indicate that the biologic width is reestablished following surgical crown lengthening. The junctional epithelium generally migrates to the apical level of root planing. Space for the supracrestal connective tissue fiber groups is created by crestal resorption of alveolar bone.

Animals↗
PubMed1999

The short-term effect of apically repositioned flap surgery on the composition of the subgingival microbiota.

The purpose of this investigation was to examine the short-term effect of apically repositioned flap surgery on clinical and microbiologic parameters in patients with adult periodontitis. A total of 11 patients with moderate to advanced periodontitis received apically repositioned flap surgery. Subjects were monitored during a 3-month pretreatment phase, the baseline surgical phase, and for 3 months post-surgery. Clinical assessments including plaque accumulation, gingival redness, suppuration, bleeding on probing, pocket depth, and attachment level were made at 6 sites per tooth. Subgingival plaque samples were taken from the mesial aspect of each tooth and the presence and levels of 29 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization. The mean levels and percentage of sites colonized by each species (prevalence) were computed for each subject at each visit. After surgery, there was a significant decrease in mean pocket depth and percentage of sites exhibiting gingival redness. Significant decreases were seen in the percentage of sites that had attachment levels < 4 mm, with a significant increase in the percentage of sites with attachment levels of 4 to 6 mm after therapy. The mean total DNA probe count for all bacterial species was significantly decreased by both scaling and root planing and surgical therapy. P gingivalis and B forsythus, 2 bacteria previously shown to be susceptible to mechanical therapy, exhibited statistically significant decreases in mean total DNA probe count. Because surgical therapy decreased levels of the suspected periodontal pathogens C rectus, P nigrescens, and C gracilis, it may be speculated that there was a potential added beneficial effect of surgery on the periodontal microbiota.

Actinomyces↗
PubMed1999

[Possibilities and efficacy of treating perio-endodontic syndrome type III].

The aim of the investigation was to assess two methods of the treatment of III type perio-endo syndrome by Simon, Glick and Frank. In group I only periodontic treatment was performed including scaling, root planing and curettage. In group II periodontic treatment was supplemented by endodontic therapy. The results were registered by: Plaque Index, Sulcus Bleeding Index, Sulcus Fluid Rate, Bone Lost Index EMR, pocket depth and tooth mobility; before treatment, 7 days after treatment, 6 weeks and 6 months after treatment. In group II in selected cases (teeth with vital pulp and pocket depth more than 6 mm), microbiological examination of the dental pulp and dental plaque from the pocket was carried out. The results showed that the periodontal therapy was not effective. In first group, after 6 months the teeths mobility was extend, the pocket depth was reduced by 1 mm only, in gingiva there was registered still with chronic inflammation and the bone growth was not significant. In the second group the teeth mobility was less significant, the pocket depth was reduced more than 3.5 mm, in 21% persons the gingiva was in good health condition and the bone growth was significant (7.5%). The anaerobic bacteria were incubated in 9 probes of dental pulp for 10 examinations.

Adult↗
PubMed2000

Using the PerioChip in treating adult periodontitis: an interim report.

Multicenter clinical trials have established that the adjunctive use of the subgingival controlled release of chlorhexidine, in the form of the PerioChip, significantly reduces pocket probing depth, improves probing attachment levels, and reduces bleeding on probing compared to scaling and root planing alone, for periods up to 9 months. The purpose of the present study was to report on the adjunctive use of the PerioChip for the long-term management of adult periodontitis for 2 years. A total of 836 patients with adult periodontitis from private dental offices were recruited into the trial. This interim report is on the first 72 patients to have completed the 2-year study. Treatments included initial definitive therapy followed by PerioChip placement in pocket sites with a pocket probing depth of > or = 5 mm after 1 month. Subsequently, the patients received routine periodontal maintenance therapy together with the placement of a PerioChip in pockets with pocket probing depths > or = 5 mm every 3 months. Results indicated that there was a continuous decrease in pocket probing depth over the 2 years (1.26 +/- 0.77 mm). This decrease in pocket probing depth was marked over the first 9 to 12 months, and then appeared to be less marked over the next 12 months. At 2 years, 60% of the patients had at least 2 pockets showing a reduction of 2 mm or more, and only 10% of the patients showed no change or increased pocket probing depth. The results indicate that adjunctive PerioChip use is a clinically effective treatment option for dental professionals and their patients for the long-term management of adult periodontitis.

Adult↗
PubMed2000

Human histologic evaluation of a bovine-derived bone xenograft in the treatment of periodontal osseous defects.

This study evaluated a bovine-derived bone xenograft (Bio-Oss) in the treatment of human periodontal osseous defects. Four patients with at least one tooth that had been recommended for extraction because of interproximal advanced periodontal disease volunteered to participate. The surgical procedure consisted of flap reflection, soft tissue debridement, placing a notch in calculus as a histologic reference point, root planing, placement of the bovine-derived xenograft and a bioresorbable physical barrier, and flap closure. Patients were seen every 2 weeks for plaque control and any necessary adjunctive treatment. At 4 to 6 months postsurgery, 6 teeth, along with the adjacent graft site, were removed en bloc. Histologic observations demonstrated new bone, new cementum, and new periodontal ligament coronal to the reference notch in 3 of the 4 specimens. This study indicates that periodontal regeneration is possible following grafting with a bovine-derived xenograft.

Absorbable Implants↗
PubMed2001

Subgingival utilization of a 1% chlorhexidine collagen gel for the treatment of periodontal pockets. A clinical and microbiological study.

This study evaluates the effect of subgingival irrigation with a 1% chlorhexidine collagen gel in periodontal pockets as an adjunct procedure to scaling and root planing (SRP). Thirty-seven sites with probing depth (PD) of 5-7 mm and BANA positive in 6 patients with chronic periodontal disease were selected. Sites were assigned to different treatment groups consisting of SRP only (group 1), SRP + irrigation with collagen gel (group 2), or SRP + irrigation with collagen gel containing 1% chlorhexidine (group 3). Subgingival irrigation was performed after initial SRP and at 7, 14 and 21 days. Clinical measurements including PD, plaque index (PI), gingival index (GI), gingival recession (GI), bleeding on probing (BOP) and clinical attachment level (CAL) were performed at the selected sites at baseline, 60 and 90 days and the BANA test was performed on plaque samples from the same sites at baseline and 90 days. There was an improvement in clinical parameters in all groups with a significantly greater decrease in GI and bleeding in the chlorhexidine group. There was a greater reduction of BANA positive sites in groups 2 and 3. The authors concluded that 1% chlorhexidine collagen gel is a promising adjunct to SRP in the treatment of adult periodontitis.

Adult↗
PubMed2001

The use of chemotherapeutic agents in localized periodontal pockets.

Gingival diseases are the most widely dispersed diseases in the United States. In some patients, periodontal disease appears in a generalized form, but more often it appears in localized areas. Furthermore, after treatment with scaling and root planing in generalized cases, the disease is often reduced to a few local areas in the patient's mouth. Because periodontitis is a bacterial infection with known pathogenic microorganisms, the local delivery of antimicrobial agents has been considered to be a possible solution for treating and controlling localized forms of periodontal disease. Three local chemotherapeutic agents are reviewed in this paper: tetracycline fiber, doxycycline gel, and chlorhexidine chip. With the advancement of local drug delivery systems, restorative dentists, periodontists, and their patients have new alternatives for the treatment of periodontal disease. Local chemotherapeutic agents offer an additional mode of therapy and should be used on a case-by-case basis, not necessarily as an initial treatment.

Anti-Bacterial Agents↗
PubMed2001

[Clinical and radiographic evaluation of 108 dental implants after 1-year loading].

OBJECTIVE: To evaluate the clinical outcomes and a possible correlation between peri-implant mucosal inflammation and marginal bone loss in a group of Chinese patients who received IMZ and Frialit-2 implants one year after restoration. METHODS: The clinical and radiography parameters of 108 IMZ and Frialit-2 dental implants in 70 patients were measured. RESULTS: There were no signs of mobility and peri-implant radiolucencies in any of the implants. The average bone loss adjacent to implants was (0.63 +/- 0.78) mm. The prevalence of peri-implant mucosal inflammation, as indicated by suclus bleeding index (SBI) of 1.0 or more, was 32.9%. Significant correlation was found between mucosal inflammation and bone loss. The severely inflamed sites experienced greater bone loss than that of healthy or slightly inflamed sites (P < 0.05). In 92% of sites, plaque index (PLI) of more than 1 was measured on implant surfaces. The periodontal status of the remaining natural teeth in each subject was evaluated using the community periodontal index of treatment need (CPITN). Of the 70 examined patients, 15 patients needed oral hygiene instruction, 44 needed scaling and root planing, 8 patients needed periodontal surgical therapy, and only 3 did not need any periodontal treatment. CONCLUSIONS: The 1-year outcomes from this patient series indicated that IMZ and Frialit-2 implant provide satisfactory clinical results. One of the etiologic factors of alveolar bone loss around implants seems to be plaque-associated marginal inflammation. Improvement of oral hygiene, elimination of marginal tissue inflammation, and proper treatment of periodontal disease of natural teeth are needed for maintaining the implants in these observed subjects.

Adolescent↗
PubMed1999

Rationale for the use of Atridox therapy for managing periodontal patients.

This article reviews the studies that provided the safety and efficacy data essential for the Food and Drug Administration approval of Atridox. These studies detail the clinical effectiveness of Atridox and provide the foundation for an understanding of the use of Atridox in the clinical management of patients with periodontitis. Atridox is a locally delivered, controlled-release system for the administration of high concentrations of doxycycline to the periodontal pocket. Nine-month clinical studies involving more than 800 patients have shown Atridox and scaling and root planing to be superior to placebo and oral hygiene for the efficacy parameters of attachment level, probing depth, and bleeding on probing. The positive clinical effects are consistent throughout a wide range of patients with varied histories of periodontal therapy. The implications of these findings as they relate to clinical practice are briefly addressed.

Animals↗
PubMed2002

[Treatment of periodontitis associated with cyclosporin-induced severe gingival hyperplasia with regular mechanical plaque removal in a patient with renal transplantation (Case report)].

A clinical case of a middle-aged kidney transplanted woman is presented. The woman has been taking Cyclosporin-A for over 13 years and has had advanced periodontitis and severe gingival swellings and gingival inflammation. The kidney transplant patient was treated and followed up for approx. four years. The treatment protocol included very thorough mechanical scaling and root planing, oral hygienic instructions and the regular professional maintenance program resulted in complete remission of the gingival overgrowth and stabilization of the periodontal condition. The gingival and periodontal conditions showed a continuing improvement over the time despite of the continuous CSA administration.

Cyclosporine↗
PubMed2002

Use of local anesthesia by dental hygienists who completed a Minnesota CE course.

PURPOSE: This study assessed the use of local anesthesia administered by dental hygienists who completed continuing education (CE) courses in Minnesota in 1996. The aims of the study were to: evaluate the use of local anesthesia by these participants; the level of effective injections; the value the dental hygienists placed on this skill; and to provide data in areas less studied, such as injection techniques utilized, and the incidence of complications. METHODS: A pretested, 34-item questionnaire; cover letter; and return self-addressed, stamped envelope were sent in 1997 to dental hygienists (N = 355) who completed a CE course in local anesthesia offered by Minnesota dental hygiene programs between January and September 1996. A reminder postcard was sent to nonrespondents two weeks after the initial return date. The survey assessed the administration experience of dental hygienists including implementation of this skill, frequency of administration, types of clients receiving local anesthesia, treatments requiring local anesthesia, choice of injection techniques, level of successful anesthesia, complications observed, and value to practice. Data were analyzed using JMP version 3.1, Pearson's chi-square and one-way ANOVA. RESULTS: The response rate was 77.7% (N = 273). Ninety-five percent of the dental hygienists who responded reported delegation of local anesthesia to them by employers. A majority of respondents (64%) implemented this new skill within one week following completion of course work. Dental hygienists in periodontal specialty practice provided local anesthesia to adult clients more frequently than those in general practice. Respondents used nerve block techniques more frequently than supraperiosteal or infiltration techniques. In general, respondents reported high success rates in achieving adequate anesthesia with a very low incidence of complications. Dental hygienists most frequently administered local anesthesia for root planing or debridement (92%). A majority of respondents also administered local anesthesia to adults and children who were treated by the dentist. The frequency of administrations was strongly related (P = 0.00) to value placed on this skill and positive outcomes to their practice. CONCLUSIONS: Dental hygienists who completed required CE course work in local anesthesia, provided safe, effective injections and reported this service to be of value to their practice. These data support the incorporation of local anesthesia into dental hygiene curricula to prepare future practitioners to provide this service to clients. Also, dental hygienists working in states not currently allowing this service, should consider these results when proposing change to their state practice acts.

Adult↗
PubMed2002

The effect of apically repositioned flap surgery on clinical parameters and the composition of the subgingival microbiota: 12-month data.

The purpose of this investigation was to examine the clinical and microbiologic effects of apically repositioned flap surgery. Eighteen patients with chronic periodontitis received initial preparation (IP) including scaling and root planing, followed at 3 months by apically repositioned flap surgery at sites with pocket depth > 4 mm. Subjects were monitored clinically and microbiologically at baseline, 3 months after IP, and at 3, 6, 9, and 12 months postsurgery. Clinical assessments of plaque accumulation, gingival redness, suppuration, bleeding on probing, pocket depth, and attachment level were made at six sites per tooth. Subgingival plaque samples were taken from the mesial aspect of each tooth, and the presence and levels of 40 subgingival taxa were determined using checkerboard DNA-DNA hybridization. Significant reductions were seen in mean pocket depth and percentage of sites exhibiting gingival redness and bleeding on probing in both sites that received IP only and in sites receiving IP followed by surgery. Mean attachment level increased significantly for both sets of sites, but the increase was greater at the surgically treated sites. The total DNA probe counts were significantly reduced at sites in both treatment groups. At surgically treated sites, 19 of 40 taxa were significantly reduced posttherapy At sites receiving IP only, 16 species were significantly reduced over time. While there were some reductions in mean counts after IP in this site group, the major reductions occurred after the surgical phase in these patients, even though these particular sites did not receive surgical therapy. The reduction in pocket depth by surgical means and the associated decrease in reservoirs of periodontal pathogens may be important in achieving sustained periodontal stability.

Adult↗
PubMed2002

Periodontal attachment loss induced by mechanical subgingival instrumentation in shallow sulci.

PURPOSE: Among the many important outcomes of the 1985 National Institute of Dental Research (NIDR) workshop on professionally administered oral hygiene procedures, were the conclusions that professional treatment (including scaling and root planing) in shallow sulci resulted in permanent loss of attachment, and that regular instrumentation should not be carried out at periodontal disease-free sites. The purpose of this paper is to examine studies related to the periodontal outcome of subgingival instrumentation in shallow sulci. METHODS: Literature published between 1982 and 2000 was searched, using the Medline database, for original research papers and review articles that focused on an association between subgingival instrumentation in shallow sites and periodontal attachment loss. References cited in key papers were manually traced when not acquired otherwise. RESULTS: Thirteen clinical studies--12 human and 1 animal--ranging in length from 6 months to 5 years, were selected for review. Periodontal attachment loss in shallow sulci (< 4.0 mm) in subjects with periodontitis was assessed as a result of manual and/or ultrasonic supra- and subgingival instrumentation. Following multiple episodes of subgingival instrumentation, probing attachment loss ranging from 0.28 mm to > or = 1.5 mm has been documented, and losses ranging from a "minor apical shift" to > 2.0 mm have been reported following a single episode of subgingival instrumentation. CONCLUSIONS: Such findings suggest important implications for the dental hygiene clinical management and maintenance of periodontally healthy patients with shallow sulci, and warrant further study.

Analysis of Variance↗
PubMed2003

Effect of periodontal therapy on sulcular sulphide level a longitudinal study.

PURPOSE: The identification of active disease sites is a leading goal in basic periodontal research. Of toxic bacterial metabolites detectable in gingival crevicular fluid, volatile sulphur compounds (VSC) have been implicated in periodontal tissue destruction. Several bacteria associated with active destructive disease are capable of producing VSC, this fact supporting the idea of sulcular VSC being a possible marker of disease activity. A new portable sulphide monitor providing chairside information on sulcular sulphide level (SU) has been developed. The aim of this study was 1) to monitor the effect of mechanical therapy on SU and clinical parameters and 2) to clarify whether SU-measurements might have the potential to detect disease activity. METHODS: 34 patients (22 M, 12 F) with generalized or localized chronic periodontitis received periodontal treatment in a private practice consisting of an oral hygiene phase (HP) lasting several weeks, scaling and root planing (SRP), and flap surgery at sites >5 mm or with furcation involvement. Subjects were examined three times (1 week after the diagnosis was made, at the end of HP and at the 1st maintenance session 3 months after SRP) recording clinical parameters (clinical attachment loss CAL, probing depth PD, bleeding on probing intensity BI, plaque index PI) and sulcular sulphide level (SU) measured by the portable monitor as as digital score ranging from 0.0 (<10 superset 6 M of S superset 2-) to 5.0 (10 superset 2 M of S superset 2-) in increments of 0.5. RESULTS: 23 patients (15 M, 8 F, 47.5 +/- 9 years) were included in the data analysis. Periodontal therapy resulted in a significant reduction of mean BI by 0.69 +/- 0.45, of mean PD by 1.39 +/- 0.33 mm and in a mean gain of attachment of 1.07 +/- 0.38 mm (p = 0.0001). The clinical improvement was accompanied by a reduction of mean SU by 0.20 +/- 0.13 and of the mean percentage of SU-positive sites per patient (SUp) by 20.09 +/- 13. SU-positive sites were located at all types of teeth. 67.9 % of SU-positive sites and 83.8 % of sites with a SU > 1 were found at the molars. 16.1 % of initially 579 SU-positive sites remained SU-positive. For these sites, BI reduction by treatment was significantly lower compared with SU-negative sites (p < 0.01). SU was significantly correlated with PD, CAL, BI and PI (p = 0.0001). Sensitivity and specificity of SU related to BOP (BI > 0) was 29.3 % and 96.8 %, respectively. CONCLUSIONS: Sulcular VSC as measured by the portable sulphide monitor may be an indicator of therapeutical success and periodontal stability. The sensor system offers chairside information on sulcular sulphide production at specific sites and is a valuable supplementation of traditional clinical methods in periodontal examination. More controlled longitudinal studies are needed to clarify the role of sulcular VSC at sites undergoing periodontal destruction.

Adult↗
PubMed2002

The challenge of treating periodontal patients who smoke--the efficacy of Arestin.

Smoking is considered a risk factor for periodontitis and an impediment to treatment. The current studies evaluated the efficacy of the local administration of 1 mg minocycline hydrochloride encapsulated in a bioresorbable polymer in periodontal pockets of > or = 5 mm in all three studies. Two hundred and seventy one patients who smoked were enrolled in the two single blind controlled studies (data pooled) with efficacy compared to scaling and root planing (SRP) and 71 smokers were enrolled in an open label study. In the three studies SRP was performed at baseline and the unit dose minocycline administered at baseline, three and six months. Efficacy and safety were measured at one, three, six, and nine months. Adjunctive treatment resulted in statistically significant pocket depth reduction in both studies in these smokers. In the controlled studies the difference in probing depth reduction between the adjunctive therapy group and the SRP alone group was statistically significant at one, three, six, and nine months. No serious adverse events were recorded in any of the studies.

Adult↗